Yang Jeong Hoon, Song Pil Sang, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Choi Jin-Ho, Lee Sang Hoon, Jeong Myung-Ho, Kim Young-Jo, Gwon Hyeon-Cheol
Crit Care. 2013 Oct 3;17(5):R218. doi: 10.1186/cc13035.
Admission blood glucose (BG) level is a predictor of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, limited data are available relating admission BG to mortality in patients with STEMI complicated by cardiogenic shock, and it is not known whether diabetic status has an independent effect on this relationship.
Between November 2005 and September 2010, 816 STEMI patients with cardiogenic shock were enrolled in a nationwide, prospective, multi-center registry; 239 (29.3%) had diabetes mellitus (DM). Patients were categorized according to BG levels at admission: <7.8, 7.8-10.9, 11.0-16.5 and ≥ 16.6 mmol/L. The primary outcome was 30-day mortality. The added values of BG to the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were assessed by receiver operating characteristic curves and integrated discrimination improvement analyses.
Thirty-day mortality was higher in patients with higher admission BG (20.4%, 23.3%, 39.8%, and 43.1% p < 0.001). Among non-diabetic patients, 30-day mortality was predicted by TIMI scores with a c-statistic of 0.615 (95% confidence interval [CI], 0.561-0.662) and GRACE scores with a c-statistic of 0.652 (95% CI, 0.604-0.695). Incorporation of admission BG increased the c-statistic for TIMI score to 0.685 (95% CI, 0.639-0.720, p < 0.001) and GRACE score to 0.708 (95% CI 0.664-0.742, p < 0.001). Additional predictive values for BG were not observed for diabetes. Integrated discrimination improvements (TIMI vs. additional BG and GRACE vs. additional BG) were 0.041 (p < 0.001) and 0.039 (p < 0.001) in non-diabetic patients.
In a cohort of patients with STEMI complicated by cardiogenic shock, admission BG was an independent predictor of increased risk of mortality only among patients without DM.
入院时血糖（BG）水平是ST段抬高型心肌梗死（STEMI）患者死亡率的一个预测指标。然而，关于STEMI合并心源性休克患者入院时BG与死亡率之间关系的数据有限，且尚不清楚糖尿病状态是否对这种关系有独立影响。
在2005年11月至2010年9月期间，816例STEMI合并心源性休克患者被纳入一项全国性、前瞻性、多中心登记研究；其中239例（29.3%）患有糖尿病（DM）。患者根据入院时BG水平进行分类：<7.8、7.8 - 10.9、11.0 - 16.5和≥16.6 mmol/L。主要结局是30天死亡率。通过受试者工作特征曲线和综合判别改善分析评估BG对心肌梗死溶栓（TIMI）和急性冠状动脉事件全球登记（GRACE）评分的增加值。
入院时BG水平较高的患者30天死亡率更高（分别为20.4%、23.3%、39.8%和43.1%，p<0.001）。在非糖尿病患者中，TIMI评分预测30天死亡率的c统计量为0.615（95%置信区间[CI]，0.561 - 0.662），GRACE评分的c统计量为0.652（95%CI，0.604 - 0.695）。纳入入院时BG后，TIMI评分的c统计量增至0.685（CI，0.639 - 0.720，p < 0.001），GRACE评分增至0.708（95%CI 0.664 - 0.742，p < 0.001）。未观察到糖尿病患者BG的额外预测价值。非糖尿病患者的综合判别改善（TIMI与额外BG以及GRACE与额外BG）分别为0.041（p < 0.001）和0.039（p < 0.001）。
在一组STEMI合并心源性休克的患者中，入院时BG仅是无糖尿病患者死亡风险增加的独立预测指标。
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